Embolic protection device

ABSTRACT

An embolic protection device has a collapsible filter element ( 105 ) mounted on a carrier such as a guidewire ( 101 ). The filter element ( 105 ) collapses into the outer end of a catheter ( 118 ) for deployment and retrieval through a vascular system of a patient. The filter element ( 105 ) has a collapsible filter body with a proximal inlet end and a distal outlet end. The proximal inlet end has inlet openings sized to allow blood and embolic material enter the filter body. The outlet end has outlet openings which allow through passage of blood but retain embolic material within the filter body. After use, the catheter ( 118 ) is movable along the guidewire ( 101 ) to engage the proximal end of the filter element and close the inlet openings before sliding over the filter element from the proximal end to the distal end to progressively collapse the filter body on the guidewire ( 101 ) for retrieval. The filter element ( 105 ) may conveniently be mounted on a tubular sleeve ( 104 ) which is slidable and rotatable on the guidewire ( 101 ) between spaced-apart stops ( 106, 120 ) on the guidewire ( 101 ) which allows some manipulation of the guidewire independently of the filter when the filter is in use.

INTRODUCTION

[0001] The Invention relates to an embolic protection device.

[0002] The term “STROKE” is used to describe a medical event wherebyblood supply to the brain or specific areas of the brain is restrictedor blocked to the extent that the supply is inadequate to provide therequired flow of oxygenated blood to maintain function. The brain willbe impaired either temporarily or permanently, with the patientexperiencing a loss of function such as sight, speech or control oflimbs. There are two distinct types of stroke, haemorrhagic and embolic.This invention addresses embolic stroke.

[0003] Medical literature describes carotid artery disease as asignificant source of embolic material. Typically, an atheroscleroticplaque builds up in the carotid arteries. The nature of the plaquevaries considerably, but in a significant number of cases pieces of theplaque can break away and flow distally and block bloodflow to specificareas of the brain and cause neurological impairment. Treatment of thedisease is classically by way of surgical carotid endarterectomywhereby, the carotid artery is cut and the plaque is physically removedfrom the vessel. The procedure has broad acceptance with neurologicalcomplication rates quoted as being low, somewhere in the order of 6%although claims vary widely on this.

[0004] Not all patients are candidates for surgery. A number of reasonsmay exist such that the patients could not tolerate surgicalintervention. In these cases and an increasing number of candidates thatare surgical candidates are being treated using transcathetertechniques. In this case, the evolving approach uses devices inserted inthe femoral artery and manipulated to the site of the stenosis. Aballoon angioplasty catheter is inflated to open the artery and anintravascular stent is sometimes deployed at the site of the stenosis.The action of these devices as with surgery can dislodge embolicmaterial which will flow with the arterial blood and if large enough,eventually block a blood vessel and cause a stroke.

[0005] It is known to permanently implant a filter in human vasculatureto catch embolic material. It is also known to use a removable filterfor this purpose. Such removable filters typically comprise umbrellatype filters comprising a filter membrane supported on a collapsibleframe on a guidewire for movement of the filter membrane between acollapsed position against the guidewire and a laterally extendingposition occluding a vessel. Exampies of such filters are shown in U.S.Pat. No. 4,723,549, U.S. Pat. No. 5,053,008, U.S. Pat. No. 5,108,419 andWO 98/33443. Various deployment and/or collapsing arrangements areprovided for the umbrella filter. However, as the filter collapses, thecaptured embolic materal tends to be squeezed outwardly towards an openend of the filter and pieces of embolic material may escape from thefilter with potentially catastrophic results. More usually, the filterumbrella is collapsed against the guidewire before removal through acatheter or the like. Again, as the filter membrane is collapsed, itwill tend to squeeze out the embolic material. Further, the umbrellafilter is generally fixed to the guidewire and any inadvertent movementof the guidewire during an interventional procedure can dislodge thefilter.

[0006] The present invention is directed towards overcoming theseproblems.

[0007] There is a need for an embolic protection device which willovercome this problem.

STATEMENTS OF INVENTION

[0008] According to the invention, there is provided an embolicprotection device comprising:

[0009] a collapsible filter element mounted on a filter carrier fordelivery through a vascular system of a patient,

[0010] the filter element being movable between a collapsed storedposition against the filter carrier for movement through the vascularsystem, and an expanded position for occluding a blood vessel such thatblood passing through the blood vessel is delivered through the filterelement,

[0011] the filter element comprising a collapsible filter body having aninlet end and an outlet end,

[0012] the inlet end of the filter body having one or more inletopenings sized to allow blood and embolic material enter the filterbody,

[0013] the outlet end of the filter body having a plurality of outletopenings sized to allow through passage of blood but to retain undesiredembolic material within the filter body,

[0014] means for closing the inlet openings at the inlet end of thefilter body, and

[0015] means for collapsing the filter body on the support.

[0016] Advantageously, the inlet openings in the filter are closedbefore the filter is collapsed ensuring retention of all embolicmaterial within the filter element.

[0017] In a particularly preferred embodiment of the inventIon, themeans for closing the inlet comprises:

[0018] a tubular filter retrieval device having an open distal end forreception of the filter element,

[0019] said distal end being engagable with a proximal inlet end of thefilter body to close the inlet openings and being slidable over thefilter body from the inlet end to the outlet end to progressivelycollapse the filter body on the filter carrier and receive the filterbody within the retrieval device.

[0020] Conveniently, the retrieval device which may be a catheter or podor the like which engages and collapses the filter element firstlyclosing the inlet openings to prevent any escape of embolic material andthen collapsing the remainder of the filter, being slid from theproximal end over the filter to the distal end of the filter.

[0021] In a particularly preferred embodiment, the collapsible filterelement is slidably mounted on the filter carrier between the a pair ofspaced-apart stops on the filter carrier for axial movement of thefilter element along the filter carrier between the stops.

[0022] Advantageously, the filter carrier which may for example be aguidewire can be moved independently of the filter element and thusaccidental movement of the guidewire is accommodated withoutunintentionally moving the filter, for example, during exchange ofmedical devices.

[0023] In a further embodiment, the filter element is rotatably mountedon the filter carrier.

[0024] In a preferred embodiment, a sleeve is slidably mounted on thefilter carrier between the stops, the length of the sleeve being lessthan the distance between the stops, the filter element being mounted onthe sleeve.

[0025] In a particularly preferred embodiment, the filter elementcomprises:

[0026] a collapsible filter net mounted on the filter carrier,

[0027] the filter net being movable between a collapsed stored positionagainst the filter carrier and an expanded position extending outwardlyof the filter carrier for deployment across a blood vessel.

[0028] Preferably, the tubular filter retrieval device comprises acatheter slidable along the filter carrier, an open distal end of thecatheter forming a housing for reception of the filter element.

[0029] In another embodiment, a proximal inlet end of the filter body isfixed to the filter carrier and a distal end of the filter body isslidably mounted on the filter carrier, although this arrangement may bereversed.

[0030] In a further embodiment, the distal end of the filter body isattached to a collar which is slidable along the filter carrier.

[0031] In a preferred embodiment, a filter support frame is mounted onthe filter carrier, the support frame being movable between a collapsedposition along the filter carrier and an extended outwardly projectingposition to support the filter body in the expanded position.

[0032] In another embodiment, the filter support frame is fixed on thefilter carrier at a proximal end of the filter body.

[0033] Preferably, the filter support frame slidably engages the filtercarrier at a distal end of the filter body. Ideally, the filter supportframe is biased into a normally extended position.

[0034] In a further embodiment, a circumferential groove is provided inthe filter body intermediate the ends of the filter body.

[0035] In another embodiment, a guide olive is provided on the filtercarrier distally of the filter body, the guide olive having acylindrical body with a tapered distal end, the cylindrical body beingengagable within a distal end of a deployment catheter, said tapereddistal end projecting outwardly of the deployment catheter to provide asmooth transition between the catheter and the filter carrier.

[0036] In a further embodiment, the net is gathered into the filtercarrier at each end of the net.

[0037] In another embodiment of the invention, there is provided anembolic protection device comprising a filter element for placing in adesired position, the filter element providing a pathway for blood andhaving means for capturing, retaining and removing undesired embolicmaterial.

[0038] In one embodiment of the invention, the pathway has means forconstricting flow to capture undesired embolic material.

[0039] In another embodiment of the invention, the filter has a proximalend and a distal end, openings in the proximal end being larger thanopenings in the distal end, the proximal end openings being sized toallow the flow of blood and embolic material to enter the filter elementand the distal end openings being sized to allow the flow of blood whilecapturing undesired emboli within the filter element.

[0040] In a further embodiment of the invention, the filter elementincludes storage means to store captured undesired embolic material inthe filter element. Preferably, the storage means comprises additionalstorage pathways within the filter element. Preferably, the filterelement defines a three dimensional matrix.

[0041] In another embodiment of the invention, the filter element is ofa polymeric porous structure. In a further embodiment of the invention,the matrix comprises a porous structure dimensioned to entrap embolicmaterial which typically ranges in size from about 100 microns to 3500microns. In a still further embodiment of the invention, the filterelement is compressible and/or foldable for loading into a deliverydevice to deliver the filter element to a desired location in thecompressed or folded state.

[0042] In one embodiment of the invention, the filter element hasmaterial removed from its structure to aid compressibility.

[0043] In another embodiment of the invention, the filter element hasmaterial removed from its structure to provide specific sizing inrelation to the size of embolic material to be trapped.

[0044] In a further embodiment of the invention, the filter element haspathways through the filter body that are inter-linked such that theflow rate through the filter may be tailored.

[0045] In another embodiment of the invention, the filter element has adistal end which is tapered such that there is a smooth transition inlateral stiffness to improve the manoeuvrabillty of the filter elementin the vascular system.

[0046] In a further embodiment of the invention, the filter element hasa soft distal portion to aid in atraumatic transport through thevascular system. Preferably, the filter element has circumferentialgrooves to reduce the lateral flexibility of the filter element.

[0047] In one embodiment of the invention, the filter element has atapered proximal end to facilitate retrieval by a removal catheter.

[0048] In another embodiment of the invention, the filter element hasinlet holes that close on pulling back into a retrieval catheter toensure retention of any collected emboli.

[0049] In a further embodiment of the invention, the filter element hasoutlet openings sized to capture embolic material of a size large enoughto impair the function of the organ receiving the blood downstream ofthe filter body element. Preferably, the filter element is sized tocapture embolic material of a size greater than 100 microns. Mostpreferably, the filter element is sized to capture embolic material of asize greater than 200 microns. Most preferably, the filter element issized to capture embolic material of a size greater than 500 microns.

[0050] In one embodiment of the invention, the filter element is sizedfor complete coverage of a vessel cross-section that allows passage ofblood and blood components.

[0051] In a still further embodiment of the invention, there is provideda device having means for placing over a medical guidewire.

[0052] In another embodiment of the invention, there is provided adevice which may be placed under a balloon or stent delivery catheter.

[0053] In a further embodiment of the invention, there is provided adevice having means for insertion through, femoral, brachial, radial,subclavian or other arterial puncture by means of a transcatheterapproach.

[0054] In one embodiment of the invention, there is provided a devicefor protection of neurological function which is inserted for theduration of a surgical intervention at or near the site of surgicalopening.

[0055] It is envisaged that two devices could be used bi-laterally inleft and right carotid arteries allowing sufficient cerebral blood flowto maintain neurological function during procedures with a high risk ofgenerating clot such as electrophysiological treatment of coronaryarrhythmias.

[0056] In a further embodiment of the invention, there is provided adevice including a delivery catheter in which an external sheath isengagable with the filter element or filter carrier to provide pushduring delivery and is removable to allow maximum space in the vascularcross-section during an interventional procedure.

[0057] In one embodiment of the invention, the external sheath is joinedto the filter element or filter carrier by a joining means. The joiningmeans may be a removable shrink tube or a removable clip. Preferably thejoining means is a compression connector such as a Tuohy Borst adapter.

[0058] In another embodiment of the invention, the delivery catheter hasa central lumen for at least part of it's length to allow it to trackover a steerable guidewire.

[0059] in a further embodiment of the invention, the external sheath issufficiently long to extend to the outside of the vasculature and ismovable proximally to release the filter element from the catheter.

[0060] In one embodiment of the invention, the delivery catheter has anexternal covering which extends beyond the push element to define afilter retention sleeve.

[0061] In another embodiment of the invention, the delivery catheter hasa spring component with a localised stepwise increasing pitch to alterstiffness characteristics to suit the target vasculature.

[0062] In a further ernbodiment of the invention, the delivery catheterhas a spring component with a localised gradually increasing pitch toalter stiffness characteristics to suit the target vasculature.

[0063] In one embodiment of the invention, the filter element is mountedon a collapsible support structure which is movable between a collapsedposition for deployment and an extended in-use positIon, means beingprovided for retaining the support structure in the collapsed positon.Preferably, the support structure comprises support arms. Preferably,the support arms are formed from a shape memory or elastic memorymaterial. Most preferably, the support arms are formed from Nitinol.

[0064] In one embodiment of the invention, the support arms areconfigured to open co-axially with the filter carrier such that they maybe restrained for removal by pulling the filter element proximally intoan appropriately dimensioned sheath.

[0065] In another embodiment of the invention, the filter element has anassociated support structure with a pre-shaped spiral arrangement suchthat it provides radial support to the filter element.

[0066] In a further embodiment of the invention, the filter supportstructure is adapted to fold into the collapsed position when pulledinto a retrieval catheter.

[0067] In one embodiment of the invention, the filter element comprisesa flexible shaped polymeric component.

[0068] In another embodiment of the invention, the shaped polymericcomponent is constructed such that fluid flow through the componentassists in opening the component from the collapsed position.

[0069] In a further embodiment of the invention, the shaped polymericcomponent is flexible and opens to make circumferential contact with thevessel wall by way of using the pressure drop across the exit filterface.

[0070] In a further embodiment of the invention the filter element ismounted on a guidewire such that the guidewire has freedom to rotateand/or move axially independently of the filter. More preferably thewire has complete freedom to rotate independently of the filter and haslimited axial movement. The limit of axial movement is determined bystops mounted on or connected to the wire. Ideally the wire can move 100mm in the axial direction independent of the filter. More ideally thewire can move less than 50 mm independently of the filter. Thisembodiment facilitates the maintenance of filter position during theexchange of catheters and permits the steering of the wire independentof the filter.

[0071] In a further embodiment of this invention the filter element isbonded to the filter mount at its proximal end and its distal end isfree to move relative to the filter mount and proximal bond so as to aidthe collapse of the filter for deployment.

[0072] In a further embodiment of the invention the filter element istapered over part or all of its length such that it is accurately sizedto the vessel over some portion of its length.

[0073] In a further embodiment of the invention the shaped polymericcomponent contains one or more circumferential grooves along its body tomaintain the circular shape of the filter element in an under sizedartery.

[0074] In one embodiment of the invention, the filter element isdirectly bonded onto a steerable medical guide wire incorporating aslidable sheath that is movable to deploy the filter.

[0075] In another embodiment of the invention, there is provided adevice incorporating a medical guidewire with a flexible segment of wiredistal to the filter so as to provide steerability of the wireparticularly prior to it being deployed.

[0076] In a further embodiment of the invention, there is provided adevice incorporating a medical guide wire with a soft distal segment soas to provide a tip section that will be atraumatic.

[0077] In a still further embodiment of the invention, there is provideda device with a porous coating on a distal end of the filter elementonly with a means for opening and closing the filter by slidable motion.

[0078] In one embodiment of the invention, the filter elementincorporates proximal tapering such that it may be pulled proximallyinto a sheath for removal in order that such pulling action willeffectively reduce the diameter of the filter and assist retrieval.

[0079] In another embodiment of the invention, the filter element has aporous structure that can be deployed and closed by way of a slidablemotion, the closure thereof caused by way of snap-fit to a protrudingrim that allows the support elements be pulled proximally, thus closingthe structure with the filter membrane attached.

[0080] In a further embodiment of the invention, there is provided adevice having a filter element which permits the incorporation of amedical guide wire in the outer wall of the filter element to facilitatethe incorporation of large inlet holes on the proximal inlet end of thefilter element.

[0081] In one embodiment of the invention, the filter element comprisesa mesh work structure with large proximal inlet holes and small distaloutlet holes wherein the mesh structure is collapsible into a smalldiameter delivery catheter and is expandable upon deployment to a shapewhich is remembered by the mesh structure either through shape memorycharacteristics or elastic memory characteristics.

[0082] In another embodiment of the invention, the filter elementcomprises a mesh work structure wherein the expansion of the filterelement within the vessel causes blood flowing through the vessel toflow through the filter element due to the filter element engaging withthe wall of the vessel to conform to the shape of the vessel bore.

[0083] In another embodiment, the filter element comprises a braidedfibrous mesh work. Preferably, distal outlet openings are defined by anarea enclosed by a series of crossing interwoven fibres. Larger proximalinlet holes are provided by the convergence of the fibres of the braidinto a few bundles which are mounted to the filter carrier. Preferably,the fibrous meshwork material is an elastic or shape memory materialsuch that it can be collapsed into a delivery catheter and recover itsenlarged shape upon deployment. The fibres of the meshwork are bonded atthe points where they cross one another. The fibres may be made fromeither a polymer or metal or a composite material.

[0084] In a further embodiment, the distal end of the filter element hasthe facility to move in the axial direction relative to the proximal endof the filter element so as to take up the exact shape of the bloodvessel.

[0085] In a further embodiment, the device has a porous coating on adistal end of the filter element only with means for opening and closingthe filter element by slidable motion. Preferably, the filter elementcomprises a collapsible wire frame having a plurality of wires, outerends of the wires being hingedly mounted on the filter carrier, thewires being hinged intermediate their ends, at one end the wires beingfixed on the filter carrier and at the other end the wires being mountedon a collar which is slidable along the filter carrier, a porous filtermesh being mounted on the wire frame. An actuating sleeve is slidableover the filter carrier to push the collar towards the fixed end of thefilter element, and a collapsing device is engagable with the collar topull back the collar away from the fixed end of the filter element tocollapse the wire frame against the filter carrier for retrieval of thefilter element.

[0086] In a still further embodiment of the invention, there is provideda filter retrieval system for use with the device comprising alongitudinal catheter with a radially deformable or elastic tip toassist the pull back of the filter into the tip.

[0087] In another embodiment of the invention, there is provided asystem incorporating a filter, a delivery catheter and a retrievalcatheter for temporary filtration of the vascular system during aninterventional procedure.

[0088] In another aspect the invention provides an embolic protectiondevice comprising:

[0089] a collapsible filter element mounted on a filter carrier fordelivery through a vascular system of a patient,

[0090] the filter element being movable between a collapsed storedposition against the filter carrier for movement through the vascularsystem, and an expanded position for occluding a blood vessel such thatblood passing through the blood vessel is delivered through the filterelement, a pair of spaced-apart stops on the filter carrier, thecollapsible filter element being slidably mounted on the filter carrierfor axial movement along the filter carrier between the stops, and meansfor collapsing the filter element on the filter carrier.

BRIEF DESCRIPTION OF DRAWINGS

[0091] The invention will be more clearly understood from the followingdescription thereof given by way of example only with reference to theaccompanying drawings in which:

[0092]FIG. 1 is a side view of an embolic protection device according tothe invention, in use;

[0093]FIG. 2 is a side view of the device of FIG. 1 in a pre-loadedposition for insertion;

[0094]FIG. 3A is a side view illustrating one method of fixing thedevice to catheter;

[0095]FIG. 3B is a side view of an embolic protection deviceincorporating the fixing of FIG. 3A;

[0096]FIG. 4 is a side view illustrating another method of fixing;

[0097]FIG. 5 is an end view of a split collar used in the fixing of FIG.4;

[0098]FIG. 6 is a side view Illustrating a further method of fixing;

[0099]FIG. 7 is an end view of a jubilee clip used in the fixing of FIG.6;

[0100]FIG. 8 is a side view of one filter element used in the device ofthe invention;

[0101]FIG. 9 is a side view of another filter element;

[0102]FIG. 10 is a side view of the filter element of FIG. 8 beingremoved;

[0103]FIG. 11 is an isometric view of another filter element in anin-use placed configuration;

[0104]FIG. 12 is a side view of the filter element of FIG. 11 in aretracted position for insertion and withdrawal;

[0105] FIGS. 13 to 15 are side views of another filter element indifferent positions;

[0106]FIGS. 16 and 17 are side views of part of a further filter elementwith a snap fit retrieval arrangement;

[0107]FIG. 18 is a perspective, partially cross-sectional view ofanother embolic protection device shown mounted in a vessel;

[0108]FIGS. 19a to 19 c are perspective views illustrating the formationof a collapsible filter support for use in the device of FIG. 18;

[0109] FIGS. 20 to 22 are perspective views of other filter elements;

[0110]FIG. 23 is an elevational view of another filter element;

[0111]FIG. 24 is a sectional view taken along the line XXIV-XXIV of FIG.23;

[0112]FIG. 25 is a sectional view taken along the fine XXV-XXV of FIG.23;

[0113]FIG. 26 is an enlarged detail view of portion of the filter;

[0114]FIG. 27 is an expanded view of the filter element of FIG. 23;

[0115]FIG. 28 is a side view illustrating one method in which thesubstrate tubing that the filter element is attached to can run over theprimary crossing guidewire;

[0116]FIG. 29 is a side view illustrating the position in which the“olive” component will sit in order to provide a smooth transitionbetween the primary crossing guidewire and the loading pod;

[0117]FIG. 30 is a perspective view of the filter element in its mostdistal position;

[0118]FIG. 31 is a perspective view of the filter element in its mostproximal position;

[0119]FIG. 32 is a perspective view of the filter element when thedistal end of the filter is not bonded to the substrate tubing;

[0120]FIG. 33 is a side view of a concertina shaped filter; A being whenthe filter is deployed and B when the filter is in its loaded shape;

[0121]FIG. 34 is a perspective view of the floating distal tip designwith a spring element incorporated distal to the floating tip:

[0122]FIG. 35 is a side view of another floating distal tip design witha spring incorporated into the distal tip;

[0123]FIG. 36 is a side view of the floating distal tip design with theshape memory alloy extending from the proximal end to the distal end;

[0124]FIG. 37 is a perspective view of the mesh design incorporating afloating distal tip;

[0125]FIG. 38 illustrates perspective views of filter geometries;

[0126]FIG. 39 shows a fibrous mesh filter design with fibres woven atthe distal end and converging into a number of bundles at the proximalend;

[0127]FIG. 40 is partially sectioned elevational view an embolicprotection device according to the invention;

[0128]FIG. 41 is a schematic sectional elevational view of the embolicprotection device of FIG. 40; and

[0129]FIG. 42 is a detail sectional view of portion of the device ofFIG. 40.

DETAILED DESCRIPTION

[0130] Referring to the drawings there are illustrated various embolicprotection devices according to the invention. The devices, in general,comprise a filter element for temporary placing in a desired positionduring a surgical or interventional procedure, typically using aguidewire and catheter. The filter element provides a pathway for bloodand has means for capturing and retaining undesired embolic materialreleased during the surgical procedure. The filter element containingthe retained embolic material is removed when the interventionalprocedure is completed. In this way the patient is protected against therisk of stroke or other complications caused by the release of undesiredembolic material during the procedure.

[0131] In one embodiment of the device it will be used in an over thewire transcatheter configuration. The clinician will cross the lesionwith a steerable guidewire. The cerebral protection device will then bethreaded over the guidewire and will be placed distal to the site of thelesion being treated. By means of actuation, or other means, the filteris deployed into the vessel and will capture emboli that are generatedor dislodged during balloon inflation and stent placement. The deviceconsists of a filter attached to a shaft that can run over the primarycrossing guidewire.

[0132] Referring initially to FIGS. 1 and 2 in this case the filterelement consists of a compressible porous structure polymeric foamfilter element 1 overmoulded onto or joined to a polymeric or metallictube or spring or other hollow support element 2. The foam filterelement 1 is compressed into a housing or pod 3 at a distal end of acatheter 6 to advance it to the required location. Once in situ thehousing 3 is withdrawn or the filter element 1 is advanced. This actionallows the compressed filter element 1 to expand to the required sizeand occlude a blood vessel 4 except for the path or paths providedthrough the filter element 1. The filter element 1 is designed toprovide a pathway or multiple pathways through for blood cells and otherblood constituents but to capture emboli of a size greater than thefilter pore size. Blood flow rate is maintained by forming the filterelement such that a local pressure drop across the filter is minimised.The filter element 1 has a proximal inlet end 7 and a distal outlet end8. The inlet end 7 has a plurality of inlet openings sized to allowblood and embolic material enter the filter element. The outlet end 8has a pluraity of outlet openings sized to allow through passage ofblood but to retain undesired embolic material within the body of thefilter element 1.

[0133] The filter element 1 in this case is of a porous structure orpolymeric foam which has a open cell structure with a typical densityless than 400 kg per cubic meter. Preferably the density will be lessthan 100 kg per cubic meter and ideally will be less than 50 kg percubic meter. The filter properties may be achieved through appropriatelysizing the pores of the foam body or additionally by removing materialto create appropriately sized pathways for blood to flow through andmeans of capturing larger sized particles. A number of configurationsfor this will be described that can tailor both the sizing and flow ratecharacteristics of the filter element 1 either independently orsimultaneously. The actuation and deployment of the filter element 1 areachieved by providing relative motion between the filter element 1 andthe covering housing 3.

[0134] It is not desirable that the catheter moves relative to thesupport element 2 during manipulation. Motion may be prevented by fixingthe inner support element 2 to the catheter 6 in a number of differentways. In the embodiment described this is achieved by way of having acatheter 6 covering the support element 2 and filter element 1 to whichit is fixed. As illustrated in FIGS. 3A and 3B the fixing may beachieved by means of a shrink wrap tube 5 that is shrunk to capture boththe covering catheter 6 and the inner support element 2. Once the filterelement 1 is in the desired position, the shrink-wrap joint is brokenusing the peel-away tab 7 to allow the outer catheter 6 to be removedproximally and leave the support element 2 and filter element 1 inplace.

[0135] A number of other workable arrangements could be used to join thesupport element 2 and catheter 6. A split collar arrangement 10 (FIGS. 4& 5) could be used that was removable by means of unlocking a screw or anumber of screws or an arrangement such as a jubilee clip 11 (FIGS. 6 &7) which could be loosened to free the bond between the components.

[0136] Another method that could be used to temporarily fix the innersupport element 2 to the outer sheath or catheter 6 is a Hemostasis HighPressure Touhy Borst Y adapter. This commercially available adapter isneeded to enable the physician to flush the sheath before being insertedinto the artery. The outer sheath or catheter may be permanentlyattached to this adapter. The inner tubular support element 2 runsthrough the Touhy Borst section of the adapter and thus through thecentre of the sheath. Tightening the Touhy Borst section releases thisgrip, thus allowing the inner tubular support element 2 and the outersheath to move relative to each other once again.

[0137] The design of the filter element 1 is shown in a typicalembodiment in FIG. 8, where a foam substrate filter body has materialremoved to create a series of channels or pathways 20 for the blood toflow through but which would cause a restriction for embolic material toprevent it going through the filter. The pathways 20 may be machinedusing a variety of methods such as laser cutting with excimer, YAG, CO2,or other laser type, freezing and machining or lost wax machining. Anumber of arrangements are possible with the sizing reflective of therequirements. In the configuration shown, the inlet holes are preferably0.5 mm or greater in size to capture large emboli while the outlet holesare less than 300 microns. These can be easily varied as required tofilter differing sized particles from a variety of fluid media in avariety of vessel sizes.

[0138] The filter media can be bonded to the tubing substrate by way ofa variety of available technologles such as mechanical, solvent oradhesive bonding and overmoulding in an arrangement such that thesubstrate is placed in the mould and the polymer material is then shotinto the mould and forms a bond at the interface between the substrateand the polymer element. Additionally, the foam or porous element couldbe extuded onto or bonded to a substrate.

[0139] It will be noted that the filter element 1 has a rounded distalend 21 to facilitate insertion and the proximal end 22 is tapered tofacilitate withdrawal. Alternatively, as illustrated in FIG. 9 thedistal end 23 may be tapered.

[0140] Referring particularly to FIG. 10 at the end of theinterventional procedure, the device can be withdrawn by means ofadvancing a large bore catheter 25 to the proximal end 22 of the filter1 and pulling the filter 1 into the catheter 25. The filter 1 willcompress and seal the proximal filter inlet openings after the initialtaper is drawn into the catheter 25 before collapsing the rest of thefilter body. Once the filter 1 has been withdrawn fully into thecatheter 25 it can then be readily removed from the patient. The filter1 will contain the captured emboli.

[0141] In another embodiment of the invention as illustrated in FIGS. 11to 15, an arrangement of spokes 30 covered with a membrane or porousfabric or mesh 31 can be folded down into a delivery sheath or pod forsubsequent deployment in the target vessel. The design consists of asubstrate shaft 33 onto which are radially or circumferentially bonded aseries of pre-shaped wires 30. The wires 30 are joined on the proximalend into a movable collar or tube 32 mounted on the substrate shaft 33and at the distal end into a fixed tube 34. The tube 32 can moveproximally and distally to the extent that it will open and close theassembly in a manner similar to an umbrella and thereby occlude thevessel. The spokes 30 may be fabricated in a range of metallic,polymeric and composite materials. The frame is covered with a porousmaterial 31, whose pore size is selected to allow the media through,effectively creating a screen filter. The covering fabric 31 could bebonded to the frame 30 by means of casting a material such as apolyurethane or PET onto the pre-formed shape. The film may then belazed or made porous by other means such as mechanical or heat punchingor by chemical etching. Additionally, incorporating a soluble particlein the polymer matrix, subsequent removal of the particle would renderthe polymer porous. Control of porosity is achieved by tailoring theratio and distribution of the particulate within the polymer matrix.

[0142] When the assembly is configured longitudinally a sheath or podmay be slid over it to cover it. As with the previous embodiment, theloaded catheter is positioned in the required location by threading itover the guidewire. Once the desired location has been reached, thesheath may be moved back and allow the assembly be exposed in thevessel. A sleeve 35 can then be moved forward to open or deploy theassembly. The relative sizing and choice of materials operates such thatthe sleeve 35 will not slide on the inner tubing unless an externalforce is applied to move it. When deployed, the device will remain openand catch whatever embolic material is moving towards the brain. At theend of the procedure, a pre-shaped component advanced over the innertube will dock with the movable tube 32 and allow it to be slid towardsthe proximal end of the device with the result that the structure isclosed. A larger sheath can then separately be advanced to the site ofthe filter and the filter may be pulled or manipulated proximally intoit. When withdrawn into the sheath or catheter, the device may then beremoved either over the guidewire or with it.

[0143] Referring to FIGS. 16 and 17 there is illustrated another embolicprotection device. In this case the filter element has a design based ona shaped thin film component bonded onto the tubing substrate. A widenumber of shapes could be made to work in the application. An elementwhich through it's preshaped form will open into a framework 40 when therestraining force is removed is attached to a tubing substrate 41. Theframe element 40 can be manufactured from a range of metallic orpolymeric components such as a shape memory alloy like Nitinol or ashape memory polymer or a shaped stainless steel or metal with similarproperties that will recover from deformation sufficiently to cause thefilm component to open. Otherwise a mechanical movement or actuation cancause the device to open. The shaped film component is attached over theframe 40. The film component can be formed by a number of knowncommercial technologies. These include blow-moulding, dip casting,solution casting, spin casting and film welding as well as adhesivejoining. The object is to produce a formed shape that can be opened inthe vessel to a size and shape to occlude it. Filtration is achieved bycreating a pattern or series of openings in the proximal and distal endsof the element that allows emboli and blood to enter the device buthaving a range of smaller openings in the distal end to allow the bloodto pass through to the distal vasculature while retaining the emboli.

[0144] While being delivered to the required site, the filter element iscovered or restrained by a sheath. By withdrawing the sheath oradvancing the filter device, the filter is uncovered and opens toocclude the vessel. During the procedure, the filter acts to capture allembolic material that attempts to flow distally. At the end of theprocedure, a sheath is advanced to the proximal end of the device andthe filter is pulled proximally into it with the retained embolicaptured in this design configuration, the emboli can easily be removedfor analysis afterwards.

[0145] The invention above is described as it relates to a device thatcan be used over a medical guidewire. The opportunity exists toconfigure the invention in a manner that it could in itself be used asthe primary crossing device. All of the filter designs described abovecould be mounted onto either the over the wire or the primary crossingdevice as described hereunder. For a primary crossing device the filterwould be bonded to a solid substrate. Some benefits would accrue in thatthe inner diameter onto which the filter could be wrapped down would besmaller because it would not need to move over another instrument. FIG.18 illustrates the differences involved. The filter element 1 is mountedon the substrate shaft 33. A collapsible filter support element 50 ismounted on the substrate shaft 33 at a proximal end of the filtercrossing guidewire 2. The stoppers can be manufactured from a range ofmetallic or polymeric components, which will permit movement of thetubing substrate 33 between them. The stoppers may also be in the formof a step in the actual medical guidewire. A large variation indistances between stoppers 63 and 64 could be made to work in thisapplication. The stoppers are sized to prevent movement of the tubingsubstrate either over or under them so that they act as a stop positionfor the tubing substrate in both their proximal and distal locations.The stoppers can be mounted onto the primary crossing guidewire by anumber of known commercial technologies; these include soldering,welding, braising, crimping and adhesive bonding. The proximal stopperwill be small enough in size to fit into the internal shaft of thedelivery catheter. The filter element can move axially and rotationallyindependently of the guidewire. This allows for good wire movement andcontrol of filter position. The filter position will be maintainedduring the exchange of catheters. Any commercially known availableguidewire can be adapted accordingly and used with this technique.

[0146]FIG. 29 refer to an “olive” 65; the olive component can bemanufactured from a range of metallic or polymeric components such aspolymeric foams, plastics, stainless steel or metal. The olive willallow a smooth transition between the guidewire 2 and the pod 3 intowhich the filter element is loaded and also allows for easy positioningof the filter element within the pod. The olive can be directly attachedto the guidewire or it may also be attached to a tubing substrate 33.The olive can be attached to the guidewire or tubing substrate by arange of known techniques such as adhesive bonding and soldering. Theolive will work as required for a range of distances distal to thefilter element. A wide number of shapes and sizes could be made to workas the olive component.

[0147]FIG. 30 refers to the filter element 1 when it is positioned inits most distal position. The filter element may achieve this positionduring loading or after deployment. The stopper element 64 prevents thefilter element 1 from moving beyond it in the distal direction.

[0148]FIG. 31 illustrates the filter element in its most proximallocation the filter element may achieve this position when deploying thedevice or after deployment. The stopper element 63 prevents the filterelement 1 from moving beyond it in the proximal direction. FIG. 32refers to a floating distal tip in this case a stopper component 66 isplaced proximal to the distal end of the filter. The most distal end ofthe filter being fixed to a marker band 70 or other suitable substrate.The marker band 70 is not fixed to the substrate tubing 33. This allowsthe distal end of the filter freedom of movement in the axial directionbeyond the stopper component. The stopper component can be made to workusing any shape or form so as to prevent movement of the distal end ofthe filter in the proximal direction beyond the point of fixturing ofthe stopper component. The stopper component may be manufactured frommetals or polymeric material, it can be joined to the tubing substrate33 by a number of existing technologies including adhesive bonding andsoldering. The stopper component 66 will work when placed in anylocation between 50 and 70. A floating distal tip on the filter elementwill facilitate the loading of the filter element into the loading podas the filter can now extend in the axial direction and therefore bewrapped down over a greater length. This will reduce the loading forcerequired and also reduce the profile of the loaded filter. The floatingdistal tip design will facilitate the loading of a large range of filterdesigns.

[0149]FIG. 33 refers to a concertina shaped filter with a floatingdistal tip. This filter geometry adds to the circumferential integrityof the filter and thus prevents the formation of creases along thelength of the filter. “A” illustrates the filter as it will be when inposition. “B” illustrates how the distal tip will extend in the axialdirection when the filter element is loaded into a loading pod. Thefloating tip design can be used to accommodate the loading of manyfilter shape designs. For the filter design shown a longer pod is neededto accommodate the increase in axial length of the filter element whenloaded.

[0150]FIG. 34 refers to the floating distal tip design with a springelement 67 incorporated into the design. The spring is placed distal tothe filter element. As previously illustrated in FIG. 33, the floatingdistal tip extends in the axial direction when loaded, the spring actsas a safety device when the filter is deployed and ensures the return ofthe floating distal tip to its primary location. The spring element willbe soft enough to allow the distal tip to extend freely in the distaldirection during loading but stiff enough to push the distal tip back toits primary location after deployment. The spring element can bemanufactured from either a polymeric or metal component. The springelement can be mounted onto a substrate 33 and a stopper component usedto prevent axial movement of the spring in the distal direction. Othermethods of keeping the distal end of the spring element stationary couldbe used such as bonding, welding, crimping, soldering or crimping thedistal end of the spring onto the substrate 33. This technique couldalso be made to work with the spring being part of the actual guidewire.There are many other configurations by which a return spring element maybe incorporated into the filter as shown in FIGS. 35 and 36.

[0151] In FIG. 35 the spring element 67 is bonded to the substrate 33 atits proximal end and the distal end of the filter element is bonded tothe spring shaft. This design allows the distal end of the filterelement to extend in the distal direction. The extension length could bedetermined by either the positioning of a stopper 68 or the stiffness ofthe spring. When external forces are removed from the filter the springwill return the filter to its primary location. In FIG. 36 a shapememory alloy such as nitinol is used to return the filter to its primarylocation. The nitinol support frarne 69 is fixed to the substrate 33 atits proximal end 70 and is floating at the distal end 71. The shapememory properties of the nitinol will ensure that the filter elementreturns to its primary location. This design can facilitate the use ofany other commercially available or known shape memory alloys. Thisdesign could also be made to work using a spring component.

[0152]FIG. 37 again incorporates the floating distal tip design. Thefilter body 65 as previously illustrated in FIG. 27 is mounted onto asubstrate 33. At the proximal end the stent is fixed to the substrate.The floating distal tip design allows the filter body 65 to extend inthe distal direction. As the filter body 65 extends there is a reductionin its outside diameter and an increase in its overall length. There mayor may not be need for a stopper 68 as the filter body 65 will extend upto its own elastic limit which is determined by its size and geometry.The shape memory function of the filter body 65 will cause the distaltip to return to its primary location when external forces are removedfrom it. The proximal end of the filter body 65 may be fixed to thesubstrate by a number of known technologies such as bonding, solderingor crimping.

[0153]FIG. 38 illustrates a number of different filter designs whichcould be made to work as embolic protection devices. These filterdesigns all work to reduce the longitudinal length of creases which mayoccur should the filter be oversized, therefore acting as creasebreakers. Either ends of the filters shown could act as both proximaland distal ends for the filter. The filter body may be tubular orfrusto-conical.

[0154] Referring to FIGS. 40 to 42 there is illustrated an embolicprotection device according to the invention indicated generally by thereference number 100. The device 100 has a guidewire 101 with a proximalend 102 and a distal end 103. A tubular sleeve 104 is slidably mountedon the guidewire 101. A collapsible filter 105 is mounted on the sleeve104, the filter 105 being movable between a collapsed stored positionagainst the sleeve 104 and an expanded position as shown in the drawingsextended outwardly of the sleeve 104 for deployment in a blood vessel.

[0155] The sleeve 104 is slidable on the guidewire 101 between a pair ofspaced-apart end stops, namely an inner stop 106 and an outer stop whichin this case is formed by a spring tip 107 at the distal end 103 of theguidewire 101.

[0156] The filter 105 comprises a mesh net 110 mounted over acollapsible support frame 111. The mesh net 110 is gathered into thesleeve 104 at each end, the net 110 being rigidly attached to a proximalend 112 of the sleeve 104 and the net 110 being attached to a collar 115which is slidable along a distal end 114 of the sleeve 104. Thus thedistal end of the net 110 is longitudinally slidable along the sleeve104. The support frame 111 is also fixed at the proximal end 112 of thesleeve 104. A distal end 116 of the support frame 111 is not attached tothe sleeve 104 and is thus also free to move longitudinally along thesleeve 104 to facilitate collapsing the support frame 111 against thesleeve 104. The support frame 111 is such that it is naturally expandedas shown in the drawings and can be collapsed inwardly against thesleeve 104 for loading in a catheter 118 or the like.

[0157] The filter 105 has large proximal inlet openings 117 and smalldistal outlet openings 119. The proximal inlet openings 117 allow bloodand embolic material to enter the filter body, however, the distaloutlet openings 119 allow through passage of blood but retain undesiredembolic material within the filter body.

[0158] An olive guide 120 is mounted at a distal end of the sleeve 104and has a cylindrical central portion 121 with tapered ends 122,123. Thedistal end 122 may be an arrowhead configuration for smooth transitionbetween the catheter and olive surfaces. The support frame 111 is shapedto provide a circumferential groove 125 in the filter net 110. If thefilter is too large for a vessel, the net may crease and this groove 125ensures any crease does not propagate along the filter.

[0159] Enlarged openings are provided at a proximal end of the filternet 110 to allow ingress of blood and embolic material into an interiorof the net 110.

[0160] In use, the filter 105 is mounted in a collapsed state within adistal end of the catheter 118 and delivered to a deployment site. Whenthe filter is correctly positioned the catheter 118 is retractedallowing the support frame 111 to expand inflating the net 110 acrossthe vessel in which the filter is mounted. Blood and emboli can enterthe enlarged openings at a proximal end of the net 110. The blood willpass through the net wall, however, the openings or pores in the net aresized so as to retain the embolic material. After use the catheter isdelivered along the guidewire 101 and slid over the filter 105 engagingthe proximal inlet end 112 first to ciose the openings and thengradually collapsing the net against the sleeve 104 as the catheter 118advances over the filter 105. Once the filter 105 is fully loaded in thecatheter 118, it can then be withdrawn.

[0161] It will be noted that a proximal end of the filter is fixed and adistal end of the filter is longitudinally movable along the sleeve tofacilitate collapsing of the filter net.

[0162] Further, the catheter engages the proximal end of the filter netfirst thus closing the filter net inlet and preventing escape of embolicmaterial from the filter net as the filter net is being collapsed.

[0163] Conveniently the tip of the catheter which forms a housing or podfor reception of the filter is of an elastic material which can radiallyexpand to accommodate the filter with the captured embolic material. Bycorrect choice of material, the same catheter or pod can be used todeploy and retrieve the filter. For deployment, the elastic materialholds the filter in a tightly collapsed posttion to minimise the size ofthe catheter tip or pod. Then, when retrieving the filter, the cathetertip or pod is sufficiently elastic to accommodate the extra bulk of thefilter due to the embolic material.

[0164] Also, the filter is not fast on the guidewire and thus accidentalmovement of the guidewire is accommodated without unintentionally movingthe filter, for example, during exchange of medical devices or whenchanging catheters.

[0165] It will also be noted that the filter according to the inventiondoes not have a sharp outer edge as with many umbrella type filters.Rather, the generally tubular filter shape is more accommodating of theinterior walls of blood vessels.

[0166] Conveniently also when the filter has been deployed in a bloodvessel, the catheter can be removed leaving a bare guidewire proximal tothe filter for use with known devices such as balloon catheter and stentdevices upstream of the filter.

1. An embolic protection device comprising: a collapsible filter elementmounted on a filter carrier for delivery through a vascular system of apatient, the filter element being movable between a collapsed storedposition against the filter carrier for movement through the vascularsystem, and an expanded position for occluding a blood vessel such thatblood passing through the blood vessel is delivered through the filterelement, the filter element comprising a collapsible filter body havingan inlet end and an outlet end, the inlet end of the filter body havingone or more inlet openings sized to allow blood and embolic materialenter the filter body, the outlet end of the filter body having aplurality of outlet openings sized to allow through passage of blood butto retain undesired embolic material within the filter body, means forclosing the inlet openings at the inlet end of the filter body, and,means for collapsing the filter body on the support.
 2. A device asclaimed in claim 1, wherein the means for closing the inlet openingscomprises: a tubular filter retrieval device having an open distal endfor reception of the filter element, said distal end being engagablewith a proximal inlet end of the filter body to close the inlet openingsand being slidable over the filter body from the inlet end to the outletend to progressively collapse the filter body on the filter carrier andreceive the filter body within the retrieval device.
 3. A device asclaimed in claim 1 wherein the collapsible filter element is slidablymounted on the filter carrier between a pair of spaced-apart stops onthe filter carrier for axial movement of the filter element along thefilter carrier between the stops.
 4. A device as claimed in claim 3,wherein the filter element is rotatably mounted on the filter carrier.5. A device as claimed in claim 3, wherein a sleeve is slidably mountedon the filter carrier between the stops, the length of the sleeve beingless than the distance between the stops, the filter element beingmounted on the sleeve.
 6. A device as claimed in claim 1, wherein thefilter element comprises: a collapsible filter net mounted on the filtercarrier, the filter net being movable between a collapsed storedposition against the filter carrier and an expanded position extendingoutwardly of the filter carrier for deployment across a blood vessel 7.A device as claimed in claim 2, wherein the tubular filter retrievaldevice comprises a catheter slidable along the filter carrier, an opendistal end of the catheter forming a housing for reception of the filterelement.
 8. A device as claimed in claim 1, wherein a proximal inlet endof the filter body is fixed to the filter carrier and a distal end ofthe filter body is slidably mounted on the filter carrier.
 9. A deviceas claimed in claims 1 wherein a filter support frame is mounted on thefilter carrier, the support frame being movable between a collapsedposition along the filter carrier and an extended outwardly projectingposition to support the filter body in the expanded position.
 10. Adevice as claimed in claim 9 wherein the filter support frame is fixedon the filter carrier at a proximal end of the filter body, and thefilter support frame slidably engages the filter carrier at a distal endof the filter body.
 11. A device as claimed in claim 9 wherein thefilter support frame is biased into a normally extended position.
 12. Adevice as claimed in claim 9 wherein a circumferential groove isprovided in the filter body intermediate the ends of the filter body.13. A device as claimed claim 1, wherein a guide olive is provided onthe filter carrier distally of the filter body, the guide olive having acylindrical body with a tapered distal end, the cylindrical body beingengagable within a distal end of a deployment catheter, said tapereddistal end projecting outwardly of the deployment catheter to provide asmooth transition between the catheter and the filter carrier.
 14. Adevice as claimed in claim 1 when the filter element includes storagemeans to store captured undesired embolic material in the filterelement.
 15. A device as claimed in claim 14 wherein the storage meanscomprises additional storage pathways within the filter element.
 16. Adevice as claimed in claim 1 wherein the filter element defines a threedimensional matrix.
 17. A device as claimed in claim 16 wherein thefilter element is of a polymeric porous structure.
 18. A device claimedin claim 16 wherein the matrix comprises a porous structure dimensionedto entrap embolic material ranging in sizw from 100 microns to 3500microns.
 19. A device as claimed in claim 1 wherein the filter elementhas a distal end which is tapered such that there is a smooth transitionin lateral stiffness to improve the manoeuvrability of the filterelement in the vascular system.
 20. A device as claimed in claim 1wherein the filter element has a soft distal portion to aid inatraumatic transport through the vascular system.
 21. A device asclaimed in claim 1 wherein the filter element has a tapered proximal endto facilitate retrieval by a removal catheter.
 22. A device as claimedin claim 1 wherein the filter element has inlet holes that close onpulling back into a retrieval catheter to ensure retention of anycollected emboli.
 23. A device as claimed claim 1 having means forplacing the device over a medical guidewire.
 24. A device as claimed inclaim 23 which may be placed under a balloon or stent delivery catheter.25. A device as claimed in any preceding claim including a deliverycatheter in which an external sheath is engagable with the filterelement or filter carrier to provide push during delivery and is removalto allow maximum space in the vascular cross-section during aninterventional procedure.
 26. A device as claimed in claim 25 whereinthe external sheath is joined to the filter element or filter carrier bya joining means.
 27. A device as claimed in claim 25 wherein thedelivery catheter has a central lumen for at least part of its length toallow it to track over a steerable guidewire.
 28. A device as claimed inclaim 25, wherein the external sheath is sufficiently long to extend tothe outside of the vasculature and is removable proximally to releasethe filter element from the catheter.
 29. A device as claimed in claim25, wherein the delivery catheter has an external covering which extendsbeyond the push element to define a filter retention sleeve.
 30. Adevice as claimed in claim 1 wherein the filter element is mounted on acollapsible support frame which is movable between a collapsed positionfor deployment and an extended in-use position, means being provided forretaining the support structure in the collapsed position.
 31. A deviceas claimed in claim 30 wherein the support frame is formed from a shapememory or elastic memory material.
 32. A device as claimed in claim 1wherein the filter element has an associated support structure with apre-shaped spiral arrangement such that it provides radial support tothe filter element.
 33. A device as claimed in claim 1 wherein thefilter has a support structure adapted to fold into the collapsedposition when pulled into a retrieval catheter.
 34. A device as claimedin claim 1 wherein the filter element comprises a flexible shapedpolymeric component.
 35. A device as claimed in claim 1 wherein thefilter element is directly bonded onto a steerable medical guide wireincorporating a slidable sheath that is movable to deploy the filter.36. A device as claimed in claim 1 incorporating a medical guidewirewith a flexible segment of wire distal to the filter so as to providesteerability of the wire particularly prior to it being deployed.
 37. Adevice as claimed in claim 1 incorporating a medical guide wire with asoft distal segment so as to provide a tip section that will beatraumatic.
 38. A device as claimed in claim 1 having a filter elementwhich permits the incorporation of a medical guide wire in or near theouter wall of the filter element to facilitate the incorporation oflarge inlet holes on the proximal inlet end of the filter element.
 39. Adevice as claimed in claim 1 wherein the filter element comprises a meshwork structure with large proximal inlet holes and small distal outletholes wherein the mesh structure is collapsible into a small diameterdelivery catheter and is expandable upon deployment to a shape which isremembered by the mesh structure either through shape memorycharacteristics or elastic memory characteristics.
 40. A device asclaimed in claim 1 wherein the filter element comprises a braidedfibrous meshwork.
 41. A filter retrieval system for use with the deviceas claimed in any preceding claim comprising a longitudinal catheterwith a deformable tip to assist the pull back of the filter into it. 42.A method for the capture and removal of embolic material from a bloodvessel during an interventional procedure comprising the steps:preparing an embolic protection device comprising a guidewire having aproximal end and a distal end, a collapsible filter element mountedadjacent the distal end of the guidewire, the filter element beingmovable between a collapsed stored position against the guidewire and anexpanded position extending laterally outwardly of the guidewire,sliding a catheter along the guidewire and over the filter element froma proximal inlet end of the filter to collapse and house the filter in adistal end of the catheter, introducing the distal end of the catheterinto the vascular system of a patient, positioning the distal end at adesired location in the blood vessel, holding the guidewire andretracting the catheter to release the filter element from the catheterinto the expanded position, filtering blood in the vessel during theinterventional procedure, after the interventional procedure advancing aretrieval catheter along the guidewire to engage a proximal inlet end ofthe filter, collapsing the filter into the distal end of the catheter,and withdrawing the catheter from the patient.